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Email^*

EXAMPLE: StudentID@students.dadeschools.net

Student Phone Number^*

Please use the following format: 5555555555

Student Birthday^*

School Name^*

If other, which school?

Race^*

Ethnicity ^*

Are you of Hispanic, Latinx, or Spanish Origin?^*

No Yes/Mexican/Mexican American/Chicano Yes/Puerto Rican Yes/Cuban Yes/anotherHispanic/Latinx/or Spanish origin Unavailable/Unknown Prefer not to say

Gender^*

Gender Self-describe

Pronouns^*

Pronoun Self-describe

What is your current employment status?^*

What is your annual household income?^*

What is the highest degree or level of education your parents have completed?^*

Do you receive free/reduced lunch?^*

Program^*

Type "High School"

Grade Level^*

Parent/ Guardian Name^*

Parent/ Guardian Email^*

Parent/ Guardian Phone Number^*

Parent/ Guardian Additional Phone Number

Instagram Handle

Home Address ^*

City^*

Zip Code^*

State^*

Country^*

Home Language^*

Access to internet/device?^*

Are there any accommodations you need to fully participate in Achieve Miami’s programs, either virtual or in-person?

Participant Waiver, Release of Liability, and Media Consent: parents/guardians OR students 18+: please read the media and consent form (CLICK HERE), which includes a media consent and liability waiver. After reviewing, please indicate below that you have read, understood, and agree to the terms in the Consent Form:

By checking the box, you are agreeing...

"UNDER 18: As a parent or guardian for the minor listed above, by selecting this option, I am certifying that I read, understood, and agree to the terms in the Consent Form on the minor's behalf."

"18+: By selecting this option, I am certifying that I read, understood, and agree to all of the terms in the Consent Form."

Please accept the terms & conditions to submit this form.

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